 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 May 2001 | Volume 134 Issue 9 Part 2 | Pages 917-925
Community studies have shown that stressful life events, psychological distress, and depressive and anxiety disorders are associated with 1) a range of medical symptoms without identified pathology, 2) increased health care utilization, and 3) increased costs. In both primary care and medical specialty samples, patients who have syndromes with ill-defined pathologic mechanisms (such as the irritable bowel syndrome and fibromyalgia) have been shown to have significantly higher rates of anxiety and depressive disorders than do patients with comparable, well-defined medical diseases and similar symptoms. Other studies show that after adjustment for severity of medical illness, patients with depression or anxiety and comorbid medical disease have significantly more medical symptoms without identified pathology than do patients with a similar medical disease alone. Both childhood maltreatment and psychological trauma in adulthood have been associated with increased vulnerability to psychiatric illness and more medical symptoms. The substantial functional impairment, distress, and costs associated with medical symptoms without identified pathology suggest that research studies promoting a better understanding of the biopsychosocial cause of these symptoms may yield pragmatic, cost-effective approaches to treatment in medical settings.
Author and Article Information
From University of Washington Medical School, Seattle, Washington.
Grant Support: By grant MH-01643 from the National Institute of Mental Health (Dr. Katon).
Requests for Single Reprints: Wayne Katon, MD, Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Box 356560, 1959 NE Pacific Street, Seattle, WA 98195-6560; e-mail, wkaton{at}u.washington.edu.
Current Author Addresses: Drs. Katon, Sullivan, and Walker: Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Box 356560, 1959 NE Pacific Street, Seattle, WA 98195-6560. INNOVATIONS IN SYMPTOM MANAGEMENT
Medical Symptoms without Identified Pathology: Relationship to Psychiatric Disorders, Childhood and Adult Trauma, and Personality Traits
Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled " Investigating Symptoms: Frontiers in Primary Care Research—Perspectives from The Seventh Regenstrief Conference " To see a complete list of the articles included in this supplement, please view its Table of Contents.
This article has been cited by other articles:
|
|
 |
|
  M. E. Geisser, C. Strader Donnell, F. Petzke, R. H. Gracely, D. J. Clauw, and D. A. Williams Comorbid Somatic Symptoms and Functional Status in Patients With Fibromyalgia and Chronic Fatigue Syndrome: Sensory Amplification as a Common Mechanism Psychosomatics, May 1, 2008; 49(3): 235 - 242. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kroenke, M. Sharpe, and R. Sykes Revising the Classification of Somatoform Disorders: Key Questions and Preliminary Recommendations Psychosomatics, August 1, 2007; 48(4): 277 - 285. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. D. Wells, K. E. Freedland, R. M. Carney, S. P. Duntley, and E. J. Stepanski Adherence, Reports of Benefits, and Depression Among Patients Treated With Continuous Positive Airway Pressure Psychosom Med, June 1, 2007; 69(5): 449 - 454. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Abeles, M. H. Pillinger, B. M. Solitar, and M. Abeles Narrative Review: The Pathophysiology of Fibromyalgia Ann Intern Med, May 15, 2007; 146(10): 726 - 734. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Meltzer-Brody, J. Leserman, D. Zolnoun, J. Steege, E. Green, and A. Teich Trauma and Posttraumatic Stress Disorder in Women With Chronic Pelvic Pain Obstet. Gynecol., April 1, 2007; 109(4): 902 - 908. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. G. Flaherty, R. Thompson, A. J. Litrownik, A. Theodore, D. J. English, M. M. Black, T. Wike, L. Whimper, D. K. Runyan, and H. Dubowitz Effect of Early Childhood Adversity on Child Health Arch Pediatr Adolesc Med, December 1, 2006; 160(12): 1232 - 1238. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Sullivan, M. J. Edlund, L. Zhang, J. Unutzer, and K. B. Wells Association between mental health disorders, problem drug use, and regular prescription opioid use. Arch Intern Med, October 23, 2006; 166(19): 2087 - 2093. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E M van de Putte, R H H Engelbert, W Kuis, J L L Kimpen, and C S P M Uiterwaal How fatigue is related to other somatic symptoms Arch. Dis. Child., October 1, 2006; 91(10): 824 - 827. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Unutzer, M. Schoenbaum, B. G. Druss, and W. J. Katon Transforming Mental Health Care at the Interface With General Medicine: Report for the Presidents Commission Psychiatr Serv, January 1, 2006; 57(1): 37 - 47. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. C. Ringsberg and G. Krantz Coping with Patients with Medically Unexplained Symptoms: Work-related Strategies of Physicians in Primary Health Care J Health Psychol, January 1, 2006; 11(1): 107 - 116. [Abstract] [PDF]
|
|
|
|
|
|
B. van den Berg, L. Grievink, R. K. Stellato, C. J. Yzermans, and E. Lebret Symptoms and Related Functioning in a Traumatized Community Arch Intern Med, November 14, 2005; 165(20): 2402 - 2407. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Thomas, J. A. Waxmonsky, P. A. Gabow, G. Flanders-McGinnis, R. Socherman, and K. Rost Prevalence of Psychiatric Disorders and Costs of Care Among Adult Enrollees in a Medicaid HMO Psychiatr Serv, November 1, 2005; 56(11): 1394 - 1401. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Reuber, A J Mitchell, S J Howlett, H L Crimlisk, and R A Grunewald Functional symptoms in neurology: questions and answers J. Neurol. Neurosurg. Psychiatry, March 1, 2005; 76(3): 307 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. Smith, J. C. Gardiner, J. S. Lyles, C. Sirbu, F. C. Dwamena, A. Hodges, C. Collins, C. Lein, C. W. Given, B. Given, et al. Exploration of DSM-IV Criteria in Primary Care Patients With Medically Unexplained Symptoms Psychosom Med, January 1, 2005; 67(1): 123 - 129. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S. Sheps, F. Creed, and R. E. Clouse Chest Pain in Patients With Cardiac and Noncardiac Disease Psychosom Med, November 1, 2004; 66(6): 861 - 867. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Tan, K. Tillisch, and E. Mayer Functional Somatic Syndromes: Emerging Biomedical Models and Traditional Chinese Medicine Evid. Based Complement. Altern. Med., June 1, 2004; 1(1): 35 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Cedraschi, J Desmeules, E Rapiti, E Baumgartner, P Cohen, A Finckh, A F Allaz, and T L Vischer Fibromyalgia: a randomised, controlled trial of a treatment programme based on self management Ann Rheum Dis, March 1, 2004; 63(3): 290 - 296. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Fann, B. Burington, A. Leonetti, K. Jaffe, W. J. Katon, and R. S. Thompson Psychiatric Illness Following Traumatic Brain Injury in an Adult Health Maintenance Organization Population Arch Gen Psychiatry, January 1, 2004; 61(1): 53 - 61. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. F. Zatzick, J. E. Russo, and W. Katon Somatic, Posttraumatic Stress, and Depressive Symptoms Among Injured Patients Treated in Trauma Surgery Psychosomatics, December 1, 2003; 44(6): 479 - 484. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. H. B. Lin, W. Katon, M. Von Korff, L. Tang, J. W. Williams Jr, K. Kroenke, E. Hunkeler, L. Harpole, M. Hegel, P. Arean, et al. Effect of Improving Depression Care on Pain and Functional Outcomes Among Older Adults With Arthritis: A Randomized Controlled Trial JAMA, November 12, 2003; 290(18): 2428 - 2429. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Bair, R. L. Robinson, W. Katon, and K. Kroenke Depression and Pain Comorbidity: A Literature Review Arch Intern Med, November 10, 2003; 163(20): 2433 - 2445. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L S Williams, W J Jones, J Shen, R L Robinson, M Weinberger, and K Kroenke Prevalence and impact of depression and pain in neurology outpatients J. Neurol. Neurosurg. Psychiatry, November 1, 2003; 74(11): 1587 - 1589. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. L. Dobkin, M. De Civita, S. Bernatsky, H. Kang, and M. Baron Does psychological vulnerability determine health-care utilization in fibromyalgia? Rheumatology, November 1, 2003; 42(11): 1324 - 1331. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. J. Katon, E. Lin, J. Russo, and J. Unutzer Increased Medical Costs of a Population-Based Sample of Depressed Elderly Patients Arch Gen Psychiatry, September 1, 2003; 60(9): 897 - 903. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. B. Mauksch, W. J. Katon, J. Russo, S. M. Tucker, E. Walker, and J. Cameron The Content of a Low-income, Uninsured Primary Care Population: Including the Patient Agenda J Am Board Fam Med, July 1, 2003; 16(4): 278 - 289. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Henningsen, T. Zimmermann, and H. Sattel Medically Unexplained Physical Symptoms, Anxiety, and Depression: A Meta-Analytic Review Psychosom Med, July 1, 2003; 65(4): 528 - 533. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Bao, R. Sturm, and T. W. Croghan A National Study of the Effect of Chronic Pain on the Use of Health Care by Depressed Persons Psychiatr Serv, May 1, 2003; 54(5): 693 - 697. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Smith, S. P. Martin-Herz, W. M. Womack, and J. L. Marsigan Comparative Study of Anxiety, Depression, Somatization, Functional Disability, and Illness Attribution in Adolescents With Chronic Fatigue or Migraine Pediatrics, April 1, 2003; 111(4): e376 - 381. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Noyes Jr., S. P. Stuart, D. R. Langbehn, R. L. Happel, S. L. Longley, B. A. Muller, and S. J. Yagla Test of an Interpersonal Model of Hypochondriasis Psychosom Med, March 1, 2003; 65(2): 292 - 300. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. H. Barrett, G. C. Gray, B. N. Doebbeling, D. J. Clauw, and W. C. Reeves Prevalence of Symptoms and Symptom-based Conditions among Gulf War Veterans: Current Status of Research Findings Epidemiol. Rev., December 1, 2002; 24(2): 218 - 227. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Chwastiak, D. M. Ehde, L. E. Gibbons, M. Sullivan, J. D. Bowen, and G. H. Kraft Depressive Symptoms and Severity of Illness in Multiple Sclerosis: Epidemiologic Study of a Large Community Sample Am J Psychiatry, November 1, 2002; 159(11): 1862 - 1868. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Noyes Jr., S. Stuart, D. R. Langbehn, R. L. Happel, S. L. Longley, and S. J. Yagla Childhood Antecedents of Hypochondriasis Psychosomatics, August 1, 2002; 43(4): 282 - 289. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. S. Ciechanowski, E. A. Walker, W. J. Katon, and J. E. Russo Attachment Theory: A Model for Health Care Utilization and Somatization Psychosom Med, July 1, 2002; 64(4): 660 - 667. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. S. Ciechanowski, W. J. Katon, J. E. Russo, and M. M. Dwight-Johnson Association of Attachment Style to Lifetime Medically Unexplained Symptoms in Patients With Hepatitis C Psychosomatics, June 1, 2002; 43(3): 206 - 212. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Matalon, T. Nahmani, S. Rabin, B. Maoz, and J. Hart A short-term intervention in a multidisciplinary referral clinic for primary care frequent attenders: description of the model, patient characteristics and their use of medical resources Fam. Pract., June 1, 2002; 19(3): 251 - 256. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. L. Komaroff Symptoms: in the Head or in the Brain? Ann Intern Med, May 1, 2001; 134(9_Part_1): 783 - 785. [Full Text] [PDF]
|
|
Article
